Malpractice litigation related to suboptimal care transitions at discharge represents the most egregious and severe of transition mishaps. Hospitals can gain critical knowledge from these incidents to improve healthcare quality and reduce future risk of liability. Historically, conceptual frameworks describing elements of optimal care transitions have focused primarily on the discharge and the handoff. A broader conceptual framework is needed to improve patient safety. To conduct the proposed planning project, we have assembled an interdisciplinary team of research experts in care transitions, physicians, safety and quality improvement officers, nurses, and legal professionals to update the conceptual framework, develop metrics, and pilot them. The long-term goal of this project is to use qualitative analysis to develop a dashboard of key metrics to be used in real-time to alert Johns Hopkins Medicine (JHM), leaders in patient safety and quality improvement, and risk management, to suboptimal care transitions processes at discharge, which may place patients at risk for adverse events, and JHM at risk for malpractice claims. Completion of this project would represent a critical step in integration of risk management activities and patient safety efforts at JHM and in medical institutions worldwide. The Specific Aims of this planning grant are to: (SA1): Refine the existing conceptual framework for understanding suboptimal care transitions at discharge using in-depth qualitative analysis of malpractice claims and associated litigation documents;(SA2): Develop pilot metrics based on the conceptual framework developed in SA1 for monitoring quality of transitional care at discharge to improve patient safety and alert organizational leaders to events that place healthcare organizations at risk for malpractice claims;and (SA3): Test the reliability and validity of pilot metrics, and their ability to identify patient safety problems and prevent malpractice. A feasible next step would be the implementation of a national safety and risk management discharge dashboard and creation of a sophisticated risk management database combined with better defined claims coding, "real-time" data from Patient SafetyNet as an intervention strategy for effective care transitions at discharge. This new system along with patient-centered procedures, Safety Attitudes Questionnaires, patient relations, patient satisfaction surveys can help to ensure the quality and safety of care, and reduce the number of claims made against hospitals. PUBLIC HEALTH RELEVANCE: Hospital discharge represents an important transition for patients and a time of increased risk for discontinuity, miscommunication and other errors. Failures in this hand-off process can lead to adverse patient outcomes and increase health care costs. Hospital managers are unable to monitor the quality of hospital discharge, due in part to the lack of reliable indicators.